Kevin Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

188169 Issued in NC

Practice address

PO Box 1049
Smithfield, NC 27577-1049

Phone

(919) 938-3848

Fax

(919) 938-1102

NPI assigned

Mar 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kevin.sullivan.1@32647.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Johnston County Public Health Department

  • State or Local Public Health Clinic/Center
  • Smithfield, NC
  • NPI 1528157211
  Medicare reassignment NPD
• County of Johnston North Carolina

  • State or Local Public Health Clinic/Center
  • Smithfield, NC
  • NPI 1710241534
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1780927897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 LEWIS STREET POB 669",
            "city": "DRYDEN",
            "state": "NY",
            "postal_code": "13053",
            "telephone_number": "607-844-8201",
            "fax_number": "607-231-4216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1049",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275771049",
            "telephone_number": "919-938-3848",
            "fax_number": "919-938-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KEVIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "188169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory J Stockbridge, OD
• Karen Lynn Storm, MS
• Renee Perry Strickland, MED, CCC-SLP
• Patricia Ross Sudler
• Mikaela Sullinger, RDN
• Sunshine Pediatrics, PA
• Allyson Harman Surles, OTR/L
• Aarron Swanson
• Tac Alpha Medical, Inc.
• Lindsay B Tart, NP

• Physician Assistant in Smithfield, NC
• Providers in Smithfield, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.